Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
The purpose of this position is to support contracted physician management objectives through participation in design, development and tactical implementation of strategic business objectives for successful retention, management and growth of the WellMed contracted primary care, specialty care and ancillary provider network. These initiatives should result in the contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors. This will drive the financial viability of the market and provide a full continuum of care for the members.
The responsibilities of this position demand a wide range of capabilities including: strategic planning and analysis skills; strong understanding of billing and collections for physicians and or medical practices; accounting knowledge and understanding of financial statements; understanding of managed care contracts; management breadth to direct and motivate; highly developed communication skills; political savvy; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will work closely with key physician groups to develop long-term strategic relationships. Train and manage Network Executive staff to provide provider education and communication. Planning will be an integral tool used to create a mutual framework of the care coordination model established to improve patient care through implementation of best clinical practices.
This position will act as the liaison between WellMed Medical Management, Inc. and the contracted physicians through close relationships with all key areas of the corporate team including, but not limited to the following: Network Management, Contracting, Finance, Credentialing, Claims, Sales & Marketing, IT, Medical Management, and Customer Service. This does not preclude the physician groups from directly contacting the various departments as is standard process supported by the Provider Manual. This position will facilitate any unresolved issues that remain as a result from following the standard process
You’ll enjoy the flexibility to telecommute* from anywhere within the Houston area as you take on some tough challenges.
- Manages Network Executive staff
- Facilitates and oversees strategic business meetings with physician groups and their staff
- Assists with and manages business projections, forecasting and budgets, both financially and with timelines, for assigned projects
- Acts as a liaison, problem solver, and facilitator between WellMed Medical Management, Inc. and the physician groups
- Produces education tools for initial training to physician office staff, periodic re-training, and in response to provider issues on a timely basis
- Responding to provider inquiries and resolving provider issues on a daily basis
- Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
- Communicates detailed information to ensure that patients are appropriately directed according to the Medical Management Plan
- Acts as a resource to physician offices for benefits, exclusions, eligibility and co-payment information as needed
- Conducts research on claims, contracts, eligibility, authorization, and negotiates processes and procedures according to contractual language in order to assist providers
- Acts as a liaison between claims, Medical Management, and specialist in maintaining provider network and notification of any changes regarding the contracts
- Continuously strives to ensure that favorable relationships are maintained while ensuring the interest of the organization and maintaining confidentiality
- Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
- Works closely with Corporate Sales & Marketing to attain Membership goals by identifying business opportunities, and retention of key physicians along with internal growth of their practices
- Continually seeks ways to improve job efficiencies
- Performs all other related duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Bachelor’s degree in Business Administration, Marketing, Healthcare Administration or a related field (5+ additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
- 5+ years of related experience in network development
- Demonstrated successful relationship management experience
- Solid working knowledge of Medicare health care operations
- Knowledge of state and federal laws relating to Medicare
- Ability and willingness to travel within the Houston Metro area and outlying counties
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Master’s degree in Business Administration, Marketing, Healthcare Administration or a related field
- 5+ years of experience in a healthcare related field
- Healthcare plan experience
- Negotiation and administration of physician and ancillary contracts
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Manager, Network Development, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, Houston, TX, Texas